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Strabismus

Topic Overview

What is strabismus?

Strabismus (say "struh-BIZ-mus") is a vision problem in which both eyes
do not look at the same point at the same time. Strabismus most often begins in
early childhood. It is sometimes called crossed-eyes, walleye, or squint.

Normally, the muscles attached to each eye work together to move both eyes in
the same direction at the same time. Strabismus occurs when the eye muscles don't work properly to control eye movement. When the eye muscles don't work
as they should, the eyes may become misaligned and the brain may not be able to
merge what one eye sees with what the other eye sees.

A child rarely
outgrows strabismus after it has developed. Without treatment, strabismus can
cause permanent vision problems. For example, if the child is not using one eye
because it is misaligned, he or she can develop poor vision in that eye (called
lazy eye or amblyopia).

Having strabismus can be hard
on your child's self-esteem. It affects your child's appearance as well as his or her ability to see well. Other kids may tease your
child for being cross-eyed or having a walleye. Be supportive of your child,
and seek treatment right away.

What causes strabismus?

Childhood strabismus often
has no known cause, although it tends to run in families.

Sometimes strabismus develops when the eyes
compensate for other vision problems, such as
farsightedness or a cataract. Other things that can increase your child's risk for strabismus include an illness that affects the muscles and nerves, premature birth, Down syndrome, a head injury, and other problems.

Adults may develop
strabismus from eye or blood vessel damage. Loss of vision, an eye tumour or a brain
tumour,
Graves' disease,
stroke, and various muscle and nerve disorders can
also cause strabismus in adults.

What are the symptoms?

The
most common signs are:

Eyes that don't look in the same direction at
the same time. (If your child's eyes are only slightly misaligned, you may
not notice.)

Eyes that don't move together.

Squinting or closing one eye
in bright sunlight.

Tilting or turning the head to look at an
object.

Bumping into things. (Strabismus limits depth
perception.)

An older child may also complain about blurred vision, tired eyes, sensitivity to light, or double vision.

Symptoms may come and go. They may get worse when your child is tired or sick.

A newborn's eyes may be
misaligned at first. But the eyes should become aligned by 3 to 4 months of age. In some
cases, the eyes may simply seem to be misaligned because the child has a wide
bridge of the nose that creates the appearance of crossed eyes. But if your child's eyes aren't aligned all
of the time after age 4 months, take your child to the doctor for an eye examination.

How is strabismus diagnosed?

The doctor may have the child look at an object while
covering and then uncovering each eye. This allows the doctor to see
which eye turns, how much it turns, and under what circumstances the abnormal
turn occurs. These tests will also help the doctor find out if the child
has
amblyopia (lazy eye), which sometimes occurs with strabismus.

The Canadian Paediatric Society recommends screening to detect lazy eye (amblyopia), misaligned eyes (strabismus), and defects in visual acuity in children younger than 5 years of age.1 But no child is too young for an eye examination. If you have concerns about your child's eyes or vision at any age, take him or her to an eye doctor.

How is it treated?

The most common treatments for
strabismus are:

Glasses. Wearing
glasses can sometimes correct mild strabismus.

A temporary eye patch over the stronger eye if your child has amblyopia. This can make the weak eye stronger, which may help align the eyes. Your child may have to wear the patch some or all of the time for a few weeks or months.

Surgery on the eye muscles. This is often the only way to improve vision and better align the eyes. It may take more than one surgery, and your child may still need to wear glasses.

Other treatments may include medicines and eye exercises.

Treatment for
strabismus should begin as soon as
possible. In general, the younger the child is when treatment begins, the better the chances are of correcting the problem.

It's also important for your child to get follow-up examinations.

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References

Citations

Community Paediatrics Committee, Canadian Paediatric Society (2009). Vision screening in infants, children and youth. Paediatrics and Child Health, 14(4): 246–248. Also available online: http://www.cps.ca/english/statements/CP/cp09-02.htm.

Other Works Consulted

American Academy of Ophthalmology Pediatric Ophthalmology/Strabismus Panel (2012). Esotropia and exotropia. (Preferred Practice Pattern). San Francisco: American Academy of Ophthalmology. Also available online: http://one.aao.org/CE/PracticeGuidelines/PPP_Content.aspx?cid=689e7270-36c6-4daf-9dab-f6b1ab7286d3.

Community Paediatrics Committee, Canadian Paediatric Society (2009). Vision screening in infants, children and youth. Paediatrics and Child Health, 14(4): 246–248. Also available online: http://www.cps.ca/english/statements/CP/cp09-02.htm.

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